‘The importance of ‘connecting’; not ‘walking on by’ in a Psychologically Informed Environment (PIE)’.

05.11.2021: I am writing this week’s PIE blog, as the lead for Psychologically Informed Environments (PIE), at the national youth homeless charity; Centrepoint, on the train back from Manchester after a day delivering reflective practice sessions to support our amazing frontline teams in the city. The very early 5am start was a bit of a shock to the system after a lovely week off last week for half term but luckily, my morning coffee kicked in quickly enough to wake me up! Hence, whilst I was walking to the service from the train station early this morning, I noticed the sculpture of the homeless person shown in the photograph above. Researching this art work later on in the day, I discovered that the near life size sculpture was created by the Canadian artist Timothy Schmatz, and actually depicts Jesus Christ as a homeless man to challenge the public to reflect (and act) on the city’s growing homelessness crises (c.f. https://www.manchestereveningnews.co.uk/news/greater-manchester-news/homeless-jesus-manchester-city-centre-14569297). Of note, this statue is located outside St Ann’s church, St Ann’s Square in Manchester, which operates as outreach project for adult rough sleepers in the city centre. This felt particularly poignant to Centrepoint, as our charity grew from a similar outreach project for homeless young people founded over 50 years ago by the Reverend Ken Leech also at a St Anne’s church, but this time in Soho, London.

Interestingly, despite walking the same route on previous occasions, and discovering that the sculpture has been in situ since early 2018, I realised I had never noticed it before (clearly this morning my coffee was stronger!) As I stood to take the photograph for this blog, I reflected how easy it had been for me to previously ‘walk on by’ what appeared to be a homeless person wrapped up from the cold lying on the bench. I wondered how often in the past I had failed to notice someone who was homeless on the streets and whether perhaps as someone who does now work in the homeless sector, am I now more aware of homelessness and do I feel more of a responsibility to act to change this now? Moreover, it left me thinking whether the presence of homelessness on our streets in the UK has become so commonplace that the majority of us might now routinely fail to notice a homeless person (or even avoid looking due to our own discomfort) unless they shout out to us to ask for spare change? Sadly, recent evidence suggests that youth homelessness has risen 40% in the past five years in the UK (c.f. https://www.theguardian.com/society/2021/oct/18/youth-homelessness-up-40-per-cent-in-five-years-says-uk-charity-centrepoint). It is estimated that approximately 121,000 young people are now homeless or at risk of homelessness (based on figures of how many young people are presenting to their local authority in need of accommodation in 2019–2020). This is a significant rise from approximately 86,000 young people in 2016–2017. This figure is also likely to increase further in the future because of the consequences of the COVID-19 pandemic, and these recent figures suggest that young people from Black, Asian and Minority Ethnic backgrounds (BAME) are disproportionately impacted.

As noted in previous blogs (e.g. https://drhelenmiles.medium.com/mental-health-homelessness-time-for-a-change-to-break-the-link-8621f6513e7), the experience of being homeless can be extremely traumatic and result in significant mental (and physical) health consequences, which can have a lasting and lifelong impact on a young person’s ability to reach their full potential. Moreover, as the UK winter approaches and temperatures drop, being homeless can actually be fatal. However, homelessness is not just those who are rough sleeping on our streets, it also includes young people who are ‘sofa surfing’ and those in unsuitable or temporary accommodation. Centrepoint staff in Manchester work with young people who are experiencing this whole range of homelessness, and as we reflected today, this can be quite challenging at times for staff due to a lack of suitable accommodation in the area and the sense of responsibility they feel for the homeless young people (affecting their own emotional well-being). I am always struck by the passion and dedication of our teams in the city, who often go above and beyond to try and help a young person to get a safe bed for the night and then support them to obtain and sustain a longer term ‘home’. Often this means spending significant time ‘connecting’ or engaging with a young person, who may struggle to form trusting relationships because their experience of the world to date is that it is hostile and unsafe place. They are often young people for whom many others have walked on by, which reinforces their sense of self as being invalid or worthless.

Consequently, as per a Psychologically Informed Environment (PIE) approach (Keats et al, 2012); the formation of that relationship between the homeless young person and their key-worker is a powerful mechanism for change. Sometimes this might be the first time that the homeless young person has experienced the containment and care of another individual for some time, if ever. This therapeutic relationship can also be a foundation for the future, as it can serve as a demonstration to them of what a secure, non-toxic and positive relationship with other people can be like. Of course, this is not always straightforward, as the homeless young person can re-enact negative past relationship experiences within this professional relationship. Therefore, reflective practice can be a valuable space to help staff to take a step back and consider what might be underlying a homeless young persons’ presenting behaviour and not take any rejection personally. Consequently, it is critical that we persist and be consistent in our interactions with the homeless young people we support, taking that PIE or trauma informed approach of giving choice, empowerment, safety and collaboration to build trust with them as much as possible.

This is important, because psychologists know that healing from trauma comes from connection with others whether that be informally, or more formally within a therapeutic setting with a professional. I would argue that what has enabled us all to get through the recent COVID-19 pandemic has been the support (whether remote, socially distanced or within our ‘bubbles’) that our friends, family and work colleagues have provided us. Recent research has highlighted that those that have experienced the most significant impact upon their mental health from the pandemic are those who are the most socially isolated (e.g. Pietrabissa & Simpson, 2020; Pancani et al, 2021). It is our connection to others, which allows us to process and move from trauma. If we do not have this connection because we are socially isolated, then our sense of self and views of the wider world and others can easily become negative, which can affect our psychological well-being and increase our risk of developing subsequent mental health issues.

Of note, we often talk about self-care in the field of mental health (i.e. what you can do to support your psychological well-being), and there is now a new NHS campaign highlighting this (see here: https://www.nhs.uk/every-mind-matters/). However, psychologists and experienced workers in homeless sector are now highlighting the importance of ‘collective care’ (e.g. Reynolds, 2019), which is how we support each other to achieve mental well-being, particularly in challenging and difficult situations. This is key in this field as the work can be very challenging and there is a high risk of vicarious trauma to ourselves (resulting from our empathy with those who have experienced trauma themselves). As the team(s) were reflecting today, although the work they do can be difficult, what gets them through each day is being able to connect to and offer support to each other.

However, connecting to and supporting others is not just something we do because we are being altruistic. It actually also benefits us! One staff member beautifully demonstrated this in one of the sessions today, and with their permission, I have included their story in this week’s PIE blog. They described how on their way to work that morning they had a near miss car accident. This event was traumatic enough, but this trauma was further compounded by the driver of the other car being racially abusive towards them before then driving off. Naturally this left them somewhat shaken as they continued their journey to work. However, on the walk to the service from the car park they passed a man, who appeared to be acting somewhat strangely, perhaps they initially wondered because he was intoxicated. Although the staff member’s initial thought was to cross over the road and walk on by, they did not and the man called out to them. They responded to the man, during which subsequent conversation the man revealed that he was struggling with his mental health and became quite distressed. At first, the staff member just listened, unconsciously creating a healing connection between two human strangers, before they spontaneously offered the man a hug. To the staff member’s surprise, the man accepted and for just that brief moment, two strangers held each other in the street. The man then thanked the staff member for ‘seeing him’ and listening (i.e. validating his experience), before they both went their separate ways and got on with their day.

When recounting this story in the reflective practice session, it was clear that the staff member had had a significant positive impact on the man they met in the street because they had not just walked on by. Although of note, what they also reflected on was actually how healing that connection had been for them too. Gone was their preoccupation with the earlier traffic accident and the subsequent racial abuse they had experienced, which could have easily challenged that staff member’s faith in the human race and lead to them experiencing a negative mood for the rest of the day. Instead what they reported feeling left with was their own sense of healing and a renewed belief that the world could be a good place through those feelings of mutual connection even with a complete stranger. The reciprocal power created through even brief meaningful connection between two people can therefore not be underestimated. Whilst I am not necessarily suggesting we need to go around hugging strangers in the street(!), this example highlights is that if we only connect with someone for a short time, or even once, that connection can change our mental state. Or to put it another way, ‘every contact counts’.

When I was listening to this story in the reflective practice session, I was reminded of a story a few years ago about the man who was reunited with a stranger who talked him down from a suicide attempt at Waterloo Bridge in London following a social media campaign: #FindMike (c.f. https://www.theguardian.com/society/2014/jan/30/man-reunited-stranger-suicide-attempt-london-bridge). The stranger did not have any professional training in mental health, but he noticed the man on the bridge. He then reached out to connect with him by speaking and listening to him until police arrived and the man was taken to a place of safety to receive the treatment and support he needed for his mental health issues. ‘Mike’ did not walk on by, instead he did that most basic of human things; he connected with the man in distress. This was the start of a long recovery journey, but it was the foundation for everything that followed. In a PIE, we need to remember that sometimes when we are working with homeless young people, it is this initial connection that is so critical; it is the foundation that everything else is built upon. Although it can feel overwhelming at times how complex their needs are and how much support they may need, every journey begins with that first step; that first ‘connection’. As a result, at Centrepoint it is important we do not do what the famous song by Burt Bacharach suggests and ‘walk on by’. Whether that is for homeless young people or our colleagues, let us challenge ourselves over this coming week to focus on noticing and connecting with others. They will benefit and actually so will we, and in the process, we can move one-step closer to creating a truly psychologically informed environment…